Primary Acquired Toxoplasmosis Retinitis (Raw Meat Diet)

This is a montage of color fundus photographs from a 50-year-old male patient with expected primary acquired toxoplasmosis retinitis. The patient was seen for a glaucoma check, however, a suspicious area for retinitis was observed and he was referred for retinal consultation. The patient stated that he noticed his right eye vision getting foggy over the previous 10-14 days. He started noticing floaters within the last 3-4 days. His intraocular pressure was 68 and he had an iritis and vitritis. The white area of retinitis (black arrow) with no adjacent scar was seen on dilated funduscopy. Note the inflammatory venous sheathing (red arrow). He had eaten steak tartare (raw ground beef) within a week before his symptoms. Toxoplasmosis serologies were drawn with the expectation of a positive IgM and negative IgG. The reports were acquired a week later with a negative IgM of 7.5 (negative if <8) and positive IgG of 285 (high if >8.7). This indicates a reactivation of previous disease rather than a newly acquired case. There would typically be a chorioretinal scar adjacent to the area of retinitis that was not observed, most likely because it is located under the white area (black arrow). Treatment was sulfamethoxazole (800 mg)/ trimethoprim (160 mg) twice daily for at least 6 weeks, and possibly longer depending on the subsequent appearance of the fundus. The intraocular pressure was controlled with topical hypotensive drops.